Week 21 - Arterial Ulcers, Gangrene, PVD, Varicose veins and venous ulcers Flashcards

1
Q

what is Leriche Syndrome

A

occurs with occlusion in the distal aorta or proximal common iliac artery

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2
Q

what is the clinical triad seen in Leriche Syndrome

A

thigh/buttock claudication
absent femoral pulses
male impotence

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3
Q

what is Buerger’s test used to do

A

assess for peripheral arterial disease in the leg

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4
Q

what are the two parts to Buerger’s test

A

The first part involves the patient lying on their back (supine). Lift the patient’s legs to an angle of 45 degrees at the hip. Hold them there for 1-2 minutes, looking for pallor. Pallor indicates the arterial supply is not adequate to overcome gravity, suggesting peripheral arterial disease. Buerger’s angle refers to the angle at which the leg is pale due to inadequate blood supply. For example, a Buerger’s angle of 30 degrees means that the legs go pale when lifted to 30 degrees.

The second part involves sitting the patient up with their legs hanging over the side of the bed. Blood will flow back into the legs assisted by gravity. In a healthy patient, the legs will remain a normal pink colour.

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5
Q

in patients with peripheral artery disease, what colour will the legs go in the second part of the Buerger’s test

A

blue initially, as the ischaemic tissue deoxygenates the blood

dark red after a short time, due to vasodilation in response to the waste products of anaerobic respiration

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6
Q

what is the dark red colour referred to as

A

rubor

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7
Q

what do leg ulcers indicate

A

the skin and tissues are struggling to heal due to impaired blood flow

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8
Q

what are arterial ulcers caused by

A

ischaemia secondary to an inadequate blood supply

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9
Q

what are the typical characteristics of arterial ulcers

A

Are smaller than venous ulcers
Are deeper than venous ulcers
Have well defined borders
Have a “punched-out” appearance
Occur peripherally (e.g., on the toes)
Have reduced bleeding
Are painful

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10
Q

what are venous ulcers caused by

A

impaired drainage and pooling of blood in the legs

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11
Q

what are the characteristics of venous ulcers

A

Occur after a minor injury to the leg
Are larger than arterial ulcers
Are more superficial than arterial ulcers
Have irregular, gently sloping borders
Affect the gaiter area of the leg (from the mid-calf down to the ankle)
Are less painful than arterial ulcers
Occur with other signs of chronic venous insufficiency (e.g., haemosiderin staining and venous eczema)

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12
Q

what are the investigations used in PAD

A

ABPI
Duplex ultrasound
angiography

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13
Q

an ABPI above what can indicate calcification of the arteries

A

above 1.3 - making them difficult to compress
this is more common in diabetic patient s

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14
Q

what are the medical treatments for management of intermittent claudication

A

atorvastatin 80mg
clopidogrel 75mg once daily
naftidrofuryl oxalate

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15
Q

what is naftidrofuryl oxalate

A

5HT2 receptor antagonist that acts as a peripheral vasodilator

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16
Q

what are the surgical treatment options for intermittent claudication

A

Endovascular angioplasty and stenting
Endarterectomy – cutting the vessel open and removing the atheromatous plaque
Bypass surgery – using a graft to bypass the blockage

17
Q

how is urgent revascularisation achieved in management of critical limb ischaemia

A

Endovascular angioplasty and stenting
Endarterectomy
Bypass surgery
Amputation of the limb if it is not possible to restore the blood supply

18
Q

what does gangrene refer to

A

the death of the tissue, specifically due to an inadequate blood supply

19
Q

what is it called when infections infect the gangrene

A

wet gangrene

20
Q

what is phantom limb pain treated with

A

gabapentin

21
Q

is oedema present in PVD

A

not commonly no

22
Q

what is a very poor prognostic sign in PVD

A

burning pain at night, due to elevation which reduces limb perfusion, and is relieved by hanging the legs over the side of the bed

23
Q

in what syndrome is erectile dysfunction seen in

A

Leriche syndrome

24
Q

what is the difference in pain between PVD and neurogenic claudication

A

pain starts in calf and typically radiates up the leg in PVD and in neurogenic claudication, pain typically starts in the buttock and radiates down the leg

25
Q

what should all patients with claudication be given

A

Statin (e.g. atorvastatin 40mg nocte) regardless of cholesterol levels
Control hypertension – for example an ACE-inhibitor (e.g. ramipril 5mg daily) or a calcium channel blocker (e.g. amlodipine 5mg daily)
β-blockers should be avoided, but are typically safe unless PAD is very severe
Antiplatelet agent – aspirin 100mg daily or clopidogrel 75mg daily – can improve claudication distance and reduce other symptoms.

26
Q

what are the indications for specialist referral in PVD

A

lifestyle limiting claudification

pain at rest

gangrene

27
Q

what is PTA

A

percutaneous transluminal angioplasty

useful for short lesions in big arteries

a balloon is used to widen the artery, which in some cases, may be enough on its own. in many cases, a stent is also placed

28
Q

what are varicose veins

A

Are tortuous dilated superficial veins
Are different to reticular veins or telangiectasia
Are caused by weak vein walls causing dilation and valve incompetence
Are often symptomless
Are investigated with Doppler venous scanning.
Can be left untreated, compressed, injected or operated on
Often recur

29
Q

what are the risk factors for varicose veins

A

↑Age
Pregnancy
↑ No. of pregnancies
Long periods of standing – e.g. occupation as a teacher, shop assistant, surgeon(!) etc
Family History

30
Q

to maintain adequate venous return against gravity, what are the two mechanisms put in place

A

the presence of valves, which prevent back-flow of blood distally

the deep venous system is assisted by pressures generated by muscles, noticeably the calf muscles

31
Q

what is thought to be the cause of varicose veins

A

weakness in the vein wall causes dilation of the vein

if it occurs around the valve, then the cusps of the valve will no longer meet in the middle and the valve will become incompetent, resulting in backflow of blood, and therefore inadequate drainage

32
Q

what are the most common valves involved in varicose vein formation

A

those around the saphenofemoral junction (in the groin), however they can occur in other places for example the junction between the short saphenous vein and the popliteal vein.

33
Q

what do secondary varicose veins result from

A

pelvis or abdominal mases, which obstruct blood from returning from the lower limbs

34
Q

what are the complications of varicose veins as a result of the veins themselves

A

bleeding
thrombophlebitis

35
Q

what are the complications of varicose veins as a result of venous hypertension

A

oedema
venous ulceration
pigmentation changes
lipodermatosclerosis
varicose exzema

36
Q
A